探讨糖皮质激素对高龄重症社区获得性肺炎的治疗价值

发布时间：2018-06-08 16:09

本文选题：糖皮质激素 + 高龄　；参考：《宁波大学》2017年硕士论文

【摘要】：目的:分析糖皮质激素辅助抗生素治疗高龄重症社区获得性肺炎的临床疗效,探讨其治疗价值。方法:选取我院2016年5月-2017年2月收治重症肺炎患者共60例,随机分为2组,每组为30例;两组患者均给予吸氧、雾化吸入、平喘、化痰、纠正水电解质平衡紊乱及营养支持等对症干预;对照组患者采用哌拉西林/他唑巴坦静脉滴注治疗,4.5g/次,3次/d,连续给药4-5d后根据病情改善情况减至2次/d;观察组患者则在此基础上加用甲泼尼龙静脉滴注,40mg/次,2次/d,第1-3天,再改为甲泼尼龙口服,8 mg/次,2次/d;休克纠正后及时停药。比较两组患者一般情况、临床症状缓解、实验室指标、住院时间、病原菌清除率、二重感染率、30天内死亡率、治疗前后CRP、PCT水平及不良反应发生率等;研究采用SPSS17.0软件进行数据分析,计量资料均以(均数±标准差)的形式表示,采用t检验;计数资料采用χ2检验;检验水准取0.05,P0.05为差异有统计学意义。结果:1、两组患者一般情况比较:观察组与对照组中一般资料比较情况相仿(P0.05)。2、两组患者临床症状体征、实验室指标改善时间及住院时间比较:观察组患者临床症状体征消失时间,白细胞计数恢复正常时间及住院时间均显著短于对照组(P0.05)。3、两组患者病原菌清除率比较:对照组和观察组患者病原菌清除率分别为53.33%、86.67%;观察组患者病原菌清除率显著高于对照组(P0.05)。4、两组患者二重感染率和30天内死亡率比较:对照组患者二次感染率和30d内死亡率分别为3.33%、3.33%;观察组患者二次感染率和30d内死亡率分别为6.67%、0.00%;两组患者二次感染率和30d内死亡率比较情况相仿(P0.05)。5、两组患者治疗前后CRP和PCT水平比较:观察组患者治疗后CRP和PCT水平显著低于对照组及治疗前水平(P0.05)6、两组患者不良反应发生率比较:对照组患者治疗过程中出现不良反应发生率为13.33%;观察组患者治疗过程中出现不良反应发生率为16.67%;两组患者不良反应发生率比较情况相仿(P0.05)。结论:糖皮质激素辅助治疗高龄重症社区获得性肺炎可有效缩短疾病康复所需时间,抑制机体炎症反应水平,且未导致二次感染和不良反应发生风险上升。
[Abstract]:Objective: to analyze the clinical efficacy of glucocorticoid-assisted antibiotics in the treatment of elderly patients with severe community acquired pneumonia. Methods: a total of 60 patients with severe pneumonia from May 2016 to February 2017 in our hospital were randomly divided into two groups, 30 cases in each group, who were given oxygen inhalation, atomization inhalation, asthma relief and phlegm reduction. To correct the disturbance of water and electrolyte balance and nutritional support. The patients in the control group were treated with piperacillin / tazobactam intravenously for 4.5g / d for 3 times / d, and the patients in the observation group were treated with 40 mg of methylprednisolone intravenously for two times a day for 1-3 days according to the improvement of their condition, and the patients in the observation group were given 40 mg of methylprednisolone intravenously for 2 times a day, and the patients in the control group were treated with intravenous drip of piperacillin / tazobactam for 3 / d. Then methylprednisolone was taken orally for 8 mg/ 2 / d, and the drug was stopped immediately after the shock was corrected. The general condition, clinical symptom relief, laboratory index, hospitalization time, pathogen clearance rate, mortality rate within 30 days of double infection rate, the level of CRPnPCT and the incidence of adverse reactions were compared between the two groups. SPSS 17.0 software was used for data analysis. The measurement data were expressed in the form of (mean 卤standard deviation), t test was used; 蠂 2 test was used for counting data; the test level was 0.05%. Results comparison of the general conditions of the two groups: the general data in the observation group and the control group were similar to that in the control group. The clinical symptoms and signs, the time of improvement of laboratory indexes and the time of hospitalization were compared between the two groups: the time of the disappearance of clinical symptoms and signs in the observation group was the same as that in the control group. White blood cell count returned to normal time and hospitalization time were significantly shorter than that of control group (P 0.05N. 3). Comparison of pathogen clearance rate between two groups: in control group and observation group, pathogen clearance rate was 53.33 and 86.67 respectively, and that in observation group was significantly lower than that in control group. The double infection rate and the mortality rate within 30 days in the two groups were higher than those in the control group (P 0.05. 4): the secondary infection rate and the mortality rate within 30 days in the control group were 3.33 and 3.33, respectively; the secondary infection rate and the mortality rate in the observation group were 6.670.000.The second infection rate and the mortality rate within 30 days in the observation group were 6.67 and 0.000.The mortality of the patients in the control group was 3.33 and within 30 days, respectively. The levels of CRP and PCT before and after treatment in the observation group were significantly lower than those in the control group and before treatment. Rate comparison: the incidence of adverse reactions in the treatment process of the control group was 13.33; in the observation group, the incidence of adverse reactions in the treatment process was 16.677.The incidence of adverse reactions in the two groups was similar to that in the control group (P 0.05). Conclusion: glucocorticoid adjuvant therapy for elderly patients with severe community-acquired pneumonia can effectively shorten the time needed for disease rehabilitation, inhibit the level of inflammatory reaction, and do not increase the risk of secondary infection and adverse reactions.
【学位授予单位】：宁波大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1

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